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RG Week special: Mapping the problem gambling maze, part 1

8 November 2019

As co-founder of the International Problem Gambling Centre and executive director of the University of Nevada’s International Gaming Institute, Dr Bo Bernhard has been on the front line of efforts to understand and treat problem gambling for 25 years.

In this first part of a two-part interview, he tells Robin Harrison how a small, underfunded area of research has evolved into an issue debated across the industry.

Speaking to some of the industry’s lifers, the people who have spent decades in gambling, it quickly becomes clear that each experienced a sliding doors moment that led them into the sector. But for Dr Bo Bernhard, as a fifth-generation Las Vegas native, it hardly seems a stretch for him to move into a career in the industry.

Yet he too has a similar story, involving sport. He was a student at Harvard, playing on the university soccer team, and when the teams were announced before a match, the players’ hometowns were read out.

“I had one professor who cared enough to come to a game and when he heard I was from Las Vegas, he suggested I do a paper for his class on responsible gambling,” Bernhard says.

This led to him attending a Gamblers Anonymous meeting and, for want of a better word, he found himself hooked. “It really captured me, this compelling group of hurting people that growing up in Las Vegas I had no idea about,” he explains.

This led to an honours thesis, which in turn led to a doctoral dissertation, to gambling becoming the focus of his research, to his involvement in establishing Las Vegas’ largest problem gambling facility. Fast forward a few years and we find him serving as executive director of the University of Nevada, Las Vegas’ International Gaming Institute.

Bernhard was involved in the launch of the problem gambling centre while he was in graduate school, before stepping down to take over the UNLV role. He now heads a 38-strong team, which looks “to deal with any question, problem or challenge you may have about the global gaming industry”.

Bitter experience
Having played that football match in 1994, Bernhard has been researching problem gambling for 25 years now. Travelling worldwide to meetings, conferences and symposiums, he admits to being amazed at how much it has grown. In May this year, UNLV held the world’s largest research conference on gambling, attracting more than 600 attendees from 35 countries.

“It was a very happy moment for me to see how this field has grown,” he says. “As a teacher I really like that part of our mission, which is teaching people, who then teach others, who then grow the field, and I’ve been really excited to be part of this wave.”

He picks out Dr Robert Custer as “the founding clinical father” and his protégé Dr Robert Hunter – one of Bernhard’s teachers – as the pioneers of problem gambling research and treatment. But as it becomes more global, he says, the importance of diversity has become more and more apparent.

“The conversation in Asia on problem gambling is quite different from that conversation in Australia, which is quite different from the United States,” Bernhard explains. “And it reflects the culture: the US is more individualistic whereas Asia is more collectivist, and the conversation is informed by those cultural norms that we’re so familiar with in broader society, which play out in similar ways with problem gambling.”

In his eyes, exporting a treatment that works in one jurisdiction or culture to another is a “real danger”. This isn’t just a viewpoint; it’s a lesson learned from bitter experience.

“I was working with the South Korean government when it opened the Kangwon Land Casino & Hotel, which is the only casino on the Korean peninsula that allows locals to gamble,” he explains. “When they were doing that they obviously needed to create a problem gambling safety net, and I came armed with data from the National Council on Problem Gambling that showed telephone helplines were a solution.

“We opened it up in South Korea, at great expense, and nobody called. What we started to learn was that, just as ‘what happens in Vegas stays in Vegas’ over here, what happens in the Korean family stays in the Korean family.

"You don’t reach out to some stranger on the phone and start airing your dirty laundry, which is shameful to you, your family and your ancestors, reflecting this sort of more collectivist anthropological mindset, where people are part of this long line of family,” Bernhard says. “The last thing they are going to do is tell strangers about shameful things.”

As he says, it wasn’t just a hunch that went wrong. The effectiveness of helplines, in the US at least, was backed up by extensive data.This, he argues, shows the importance of cultural sensitivity – “I know that’s a cliché,” he says – but it’s hard to disagree.

For example, at May’s research conference, Japanese treatment professionals told delegates about how they incorporated a Buddhist mindset into treatment. In essence, this is a focus on mindfulness and meditation, with the problem gambler exploring their thoughts, and where the gambling urge comes from, to control it and avoid action on it.

Essentially, the professionals were describing what would be called cognitive behavioural therapy (CBT) in the West. “But this Buddhist approach will work far better in Japan than me coming in wearing my white coat telling people I’m going to introduce them to CBT,” Bernhard says. “That would flame out and die.”

His scepticism of ‘silver bullet’ measures extends to new controls such as voluntary limits and even emerging responsible gaming solutions, including affordability checks.

“Even some of the noble intentions, such as affordability checks, may flag one person who may be in a very different situation to another who may also be flagged, and put them in the same box,” he says. “As a researcher I’m also concerned about the well-intentioned measures that may ultimately have a negative effect.”